The prostate gland is a thick ring of muscle and gristle that lies between the outlet of the bladder and the penis. It is rather like the bung in the outlet of a home made wine bottle, holding the outflow tube in place. It lies deeply behind the bone in the front of the pelvis (which is the lower part of your abdomen).

It makes the fluid that carries sperm. Sometimes the centre of the prostate ring becomes narrow because of overgrowth or scarring. This causes difficulty in passing urine, as well as back-pressure effects on the bladder and kidneys.

The Operation

The back wall of the prostate ring is cut using an instrument passed up the penis. Most patients have a general anaesthetic, so that they are asleep during the operation. It is quite common, however, for patients to be numbed from the waist down with an injection in the back. If this is the case, you will be awake during the operation, but feel no pain. The operation takes about 20 minutes. You will be in hospital for about two days.

Any Alternatives

If you just have a little slowness when passing urine and are having to get up onec or twice at night to pass urine, simply waiting and seeing if you have more trouble is a reasonable idea. If you find your life is being upset by the prostate problem, then treatment is sensible. Drug treatment may be helpful in the short term, but there may be side-effects. A complete blockage definitely needs treatment, at first with a drainage tube (catheter) through the penis or through the lower tummy wall, followed usually with a cut of the back wall of the prostate ring made through the penis. A formal coring out of the prostate is needed if the gland is over a certain size. Keeping the path through the prostate using short indwelling tubes are experimental. An open operation through the tummy is rarely needed, unless the prostate is very big, or you have some bladder condition such as large bladder stones or a blowout on the bladder wall. Sometimes a permanent catheter with a collecting bag for urine strapped to the leg is the best plan if an operation would be very risky.

Before the operation

Stop smoking and get your weight down. (See Healthy Living). If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Bring all your tablets and medicines with you to the hospital. On the ward, you may be checked for past illnesses and may have special tests to make sure that you are well prepared and that you can have the operation as safely as possible. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks.

After – In Hospital

You should be able to return to a light job in one week and a heavy one in two weeks. You may restart sexual relations within a week or two, when the wound is comfortable enough. You may find that at intercourse no liquid comes, and that afterwards you notice milky fluid in the urine. This can happen in up to 80% of cases and is because the widened prostate ring allows the sperm to pass up into the bladder instead of down the penis. You may be sterile. Some men (5-10%) find that after the operation they cannot have sex as well as they could before it.

After – At Home

If you have this operation under general anaesthetic, there is a very small risk of complications related to your heart and lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.

If you have an anaesthetic injection at the back, there is a very small chance of a blood clot forming on top of your spine which can lead to a feeling of numbness or pins and needles in your legs. Most of the time the clot dissolves on its own and this solves the problem. Extremely rarely, the injections can cause permanent damage to your spine. In the first 48 hours, bleeding in the urine may be a problem. The medical and nursing staff will deal with this. There is a 5% chance that a blood transfusion may be required because of the blood loss.

Chest infections may arise, particularly in smokers. Do not smoke. Getting out of bed as quickly as possible, being as mobile as possible and co-operating with the physiotherapists to clear the air passages is important in preventing an infection. When the catheter is first removed you may notice that you want to pass urine every few minutes. This is normal and passes off in a day or two. Sometimes after removal of the catheter there is difficulty passing urine at all. It may mean replacing the catheter for three days or more. Sometimes after removal of the catheter there is some dribbling or moistness from the penis after passing urine. This improves with time and the improvement can continue gradually for up to three months. However, there is about 1% chance that you may experience mild to moderate urine incontinence in the long term. Ask the surgeon for advice if it is troublesome.

Infection of the urine can give a burning feeling and a need to pass urine every hour or so. This can be tested and treated by the surgical team. Sometimes blood stains the urine again 7 to 10 days after the operation. You should seek medical advice, but the condition settles down.

There is 10-15% chance that the prostate ring becomes narrow again over months or years. If this happens you should seek medical advice. It is most likely you will need another operation to fix the problem.

Possible Complications

If you have this operation under general anaesthetic, there is a very small risk of complications related to your heart and lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.

If you have an anaesthetic injection at the back, there is a very small chance of a blood clot forming on top of your spine which can lead to a feeling of numbness or pins and needles in your legs. Most of the time the clot dissolves on its own and this solves the problem. Extremely rarely, the injections can cause permanent damage to your spine.

In the first 48 hours, bleeding in the urine may be a problem. The medical and nursing staff will deal with this. There is a 5% chance that a blood transfusion may be required because of the blood loss.

Chest infections may arise, particularly in smokers. Do not smoke. Getting out of bed as quickly as possible, being as mobile as possible and co-operating with the physiotherapists to clear the air passages is important in preventing an infection. When the catheter is first removed you may notice that you want to pass urine every few minutes. This is normal and passes off in a day or two. Sometimes after removal of the catheter there is difficulty passing urine at all. It may mean replacing the catheter for three days or more. Sometimes after removal of the catheter there is some dribbling or moistness from the penis after passing urine. This improves with time and the improvement can continue gradually for up to three months. However, there is about 1% chance that you may experience mild to moderate urine incontinence in the long term. Ask the surgeon for advice if it is troublesome.

Infection of the urine can give a burning feeling and a need to pass urine every hour or so. This can be tested and treated by the surgical team. Sometimes blood stains the urine again 7 to 10 days after the operation. You should seek medical advice, but the condition settles down. There is 10-15% chance that the prostate ring becomes narrow again over months or years. If this happens you should seek medical advice. It is most likely you will need another operation to fix the problem.

Each ear is made up of 3 parts. There is the outer ear which you can see, and which gathers the sound. Further in, the outer ear joins the middle ear on each side of the head. Deeper still, there is an inner ear on each side. The sound goes down the ear tube, which is part of the outer ear, into the middle ear on that side.

The ear drum stretches across the deepest part of the ear tube between the outer ear and the middle ear.The drum is about 8 mm (a third of an inch) across. It is made of thin skin like the top of a real drum. Your ear drum has a hole in it, which doctors call a perforation. Germs may go through the hole and cause an ear infection, particularly if you get water in the ear whilst hair washing, taking a shower or swimming. The hole in the ear drum will stop it from vibrating normally, and this may cut down your hearing. Sealing up the hole in the ear drum should prevent you getting so many ear infections, and may improve the hearing. Just how much hearing improvement depends where in the drum the hole is, and how big it is.

The Operation

You have a general anaesthetic and are completely asleep. A cut will be made in the skin above your ear. From inside this cut the surgeon will take a small, thin piece of tissue. This tissue is called a graft, and the surgeon will use it to seal up the hole in your ear drum. The surgeon will shine a microscope inside your ear, and the rest of the operation is carried out through the ear passage. Using very, very small instruments, the ear drum is lifted up and the graft is put underneath the ear drum and spread out to seal up the hole. A small amount of some sticky-spongy dissolvable material is placed on each side of the graft (in the ear tube and the middle ear) to support the graft until it heals and seals up the hole. This material will just melt away in a few weeks. A dressing soaked in antibiotic drops will then be put into the ear passage, and stays in place for about three weeks whilst the graft and ear drum are healing up. Cotton-wool padding is placed over the ear and held in place with a bandage. Because you are asleep you will not feel any pain during the operation. You will be in the hospital for one or two days depending upon your progress.

Any Alternatives

Sometimes holes in the ear drum heal themselves. In your case this has not happened. Drops or tablets will not make the hole close up. If the hole is left open you risk getting more ear infections every time you get water in the ear.

Before the operation

Stop smoking and get your weight down if you are overweight. (See Healthy Living). If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check the hospital’s advice about taking the Pill or hormone replacement therapy (HRT). Check you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first few days after the operation. Sort out any tablets, medicines or inhalers that you are using. Keep them in their original boxes and packets. Bring them to the hospital with you. On the ward, you may be checked for past illnesses and may have special tests to make sure that you are well prepared and that you can have the operation as safely as possible. Please tell the doctors and nurses of any allergies to tablets, medicines or dressings. You will have the operation explained to you and will be asked to fill in an operation consent form. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks. If you have a cold in the week before your admission to hospital, please telephone the ward and let the ward sister know. The operation will usually be put off, and you will be given time to get better before being sent for again. You will have to get over the cold before the operation can be done because by having an anaesthetic the cold could turn into a serious infection in the chest.

After – In Hospital

You may be given oxygen from a face mask for a few hours if you have had any chest problems in the past. Your ear will be a little sore after the operation. There may be some discomfort in your ear when opening and closing your mouth, or if you lie on the ear. You will be given an injection or tablets to control this discomfort. Ask for more if the pain is not well controlled or if it gets worse. A general anaesthetic may make you slow, clumsy and forgetful for about 24 hours. The nurses will help you with everything you need until you are able to do things for yourself. Do not make important decisions during this time. You must not blow your nose, and you must not stifle any sneezing. You may have some dizziness for the first 24 hours after the operation, but this is not very common. Medicine can be given to stop the dizziness. You may notice a strange squelching, buzzing or popping noise in your ear. This is usually due to the dressing in the ear, it is expected and you should not worry about it. The noises usually stop when the dressing is removed. Some soreness or stiffness when opening your mouth is common after ear operations. It usually stops within one or two weeks. The stitches above your ear need to stay in for seven days. You must be careful when taking a shower and washing your hair not to get the ear or the wound above it wet. You will probably be given a time to return to the ward a week after your operation, for the stitches to be removed. You will be given an appointment card to come back to the ENT (ear, nose and throat) outpatient clinic about three weeks after the operation, when the surgeon will remove the dressing from the ear passage. He will examine your ear carefully and tell you whether the operation has been successful. The nurses will advise about sick notes, certificates etc.

After – At Home

Take two painkilling tablets every six hours to control any pain or discomfort. Be sure to keep the ear dry and do not go swimming. You should also avoid flying until the doctor confirms that the graft has successfully closed the hole. This is because changes in the ear pressure especially during take off and landing can push the graft out of place. You may feel rather tired for a week or so, but this will steadily improve. You should be able to go back to work after 10 days, but you must keep your ear dry. It will be better for somebody to drive you home after the operation or for you to take a taxi.

Possible Complications

As with any operation under general anaesthetic, there is a very small risk of complications related to your heart and lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.

Provided the advice given above is followed, you are unlikely to have any problems. There is a small risk that the ear may bleed when you get home. If this happens come back to the ward. If possible try and avoid catching a cold in the first month or so after your operation. Try and avoid contact with friends or relatives who have colds. If you catch a cold you should go to your doctor for antibiotics as there is a risk that a cold could lead to an ear infection which would destroy the graft while it is healing. If the ear becomes very painful, or if you develop a temperature or a headache it may mean that the ear is infected and you should return to the ward. A continuous discharge form the ear (especially if it is thick, green and/or yellow or smelly) is also a significant indication of an infection and you will need immediate medical attention. If you get an ear infection, you will need antibiotics for a week or two to control it. Remember any infection in the early stages after the operation will destroy the graft.

A rare complication is damage during the operation of a small nerve that runs behind the ear drum. If this happens, you will experience some loss of taste and/or numbness on the side of the tongue. This usually gets much better with time in most cases.

Overall the success rate of this operation is about 90%. If your ear drum is badly scarred from previous infections this will lower the success rate of the operation.